Severe mental illness and cardioprotective medication prescribing: qualitative study in general practice.

BACKGROUND:Patients with severe mental illness (SMI) die 10-20 years earlier than the general population. They have a higher risk of cardiovascular disease (CVD) yet may experience lower cardioprotective medication prescribing. AIM:To understand the challenges experienced by GPs in prescribing cardioprotective medication to patients with SMI. DESIGN AND SETTING:A qualitative study with 15 GPs from 11 practices in two Scottish Health Boards, including practices servicing highly-deprived areas (Deep End). METHOD:Semi-structured 1:1 interviews with fully-qualified GPs with clinical experience of patients with SMI. Interviews were transcribed verbatim and analysed thematically. RESULTS:Participants aimed to routinely prescribe cardioprotective medication to relevant patients with SMI but were hampered by various challenges. These included: lack of funding for chronic disease management, insufficient consultation time, workforce shortages, IT infrastructure and navigating boundaries with mental health services. Patient-related challenges included: patients' complex health and social needs, their understandable prioritisation of mental health needs/existing physical conditions and presentation during crises. Participants emphasised continuity of care as fundamental in engaging this patient group in effective cardiovascular health management. A cross-cutting theme was the currentGP workforce crisis leading to 'firefighting' and diminishing capacity for primary prevention. This was particularly acute in Deep End practices, which have a high proportion of patients with complex needs and greater resource challenges. CONCLUSION:Although participants aspire to prescribe cardioprotective medication to patients with SMI, professional, system and patient-level barriers often make this challenging, particularly in deprived areas due to patient complexity and the inverse care law.